Provider Demographics
NPI: | 1629143037 |
---|---|
Name: | JACKSON COUNTY SCHNECK MEMORIAL HOSPITAL |
Entity Type: | Organization |
Organization Name: | JACKSON COUNTY SCHNECK MEMORIAL HOSPITAL |
Other - Org Name: | SCHNECK MEDICAL CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VP FINANCE AND CFO/TREASURER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | DEBORAH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MANN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 812-522-2349 |
Mailing Address - Street 1: | 411 W TIPTON ST |
Mailing Address - Street 2: | |
Mailing Address - City: | SEYMOUR |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 47274-2363 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 812-522-2349 |
Mailing Address - Fax: | 812-522-0792 |
Practice Address - Street 1: | 411 W TIPTON ST |
Practice Address - Street 2: | |
Practice Address - City: | SEYMOUR |
Practice Address - State: | IN |
Practice Address - Zip Code: | 47274-2363 |
Practice Address - Country: | US |
Practice Address - Phone: | 812-522-2349 |
Practice Address - Fax: | 812-522-0792 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-11-21 |
Last Update Date: | 2017-05-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 005330 | 103TC0700X, 133V00000X, 207L00000X, 207Q00000X, 207RG0100X, 207RH0003X, 207RP1001X, 208M00000X, 363L00000X, 363LA2200X, 363LF0000X, 367500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 381039V | Other | SIHO PROVIDER NUMBER |
IN | 381039V | Other | SIHO PROVIDER NUMBER |
IN | 941010 | Medicare ID - Type Unspecified | MEDICARE PROVIDER NUMBER |